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 RR29. Long-Term Outcomes and Sac Volume Shrinkage After Endovascular Popliteal Artery Aneurysm Repair

Michele Piazza1, Mirko Menegolo1, Alessandra Ferrari1, Joseph J. Ricotta2, Franco Grego1, Michele Antonello1
1Vascular and Endovascular Surgery Clinic, Padova University, Italy; 2NorthSide Heart and Vascular Institute, Atlanta, GA.

OBJECTIVES: To evaluate long-term outcomes and sac volume (SV) shrinkage after endovascular popliteal artery aneurysm repair (EVPAR).
 
METHODS: A retrospective review of EVPAR cases performed between January 1999 and December 2012. SV shrinkage, long-term patency, limb salvage (LS) and survival (S) were evaluated with K-M estimates. Anatomical characteristics and clinical presentation were evaluated for their association with patency using multiple logistic regression.
 
RESULTS: Forty-six EVPAR procedures in 42 patients. Mean age was 68 years, 86% were male; mean SV 42±12cm3. Elective repair in 91% of cases, while 9% treated for rupture or thrombosis; 56% were asymptomatic, 35% had claudication and 9% rest pain. Technical success was 98%. At mean follow-up of 84 months (range 6-138 months) primary, assisted primary and secondary patency was 63%, 68% and 68%; LS was 96% and S 81%. Of the 13 limbs with stent graft failure, 7 required conversion, 2 underwent amputation, while 4 remained with mild claudication. Of those with graft occlusion, 61% (8 out of 13) of cases occurred within the first year of follow-up. The overall mean difference in aneurysm SV shrinkage at 7 years was significant (42±12cm3 vs. 21±8cm3; p=0.02). The association of covering a length >20cm and distal landing zone between 1 and 1.5cm from the takeoff of the anterior tibial artery (ATA) was a negative predictor for improved patency (OR,3.05;95% CI, 1.9 to 2.3; p=0.005).
 
CONCLUSIONS: EVPAR provides successful aneurysm exclusion with acceptable long-term patency, excellent LS and S. However, close surveillance is required, particularly within the first post-operative year. Patients requiring coverage >20cm and a distal landing zone between 1 and 1.5cm from the ATA may be at increased risk for failure.
 
AUTHOR DISCLOSURES: M. Antonello: Nothing to disclose; A. Ferrari: Nothing to disclose; F. Grego: Nothing to disclose; M. Menegolo: Nothing to disclose; M. Piazza: Nothing to disclose; J. J. Ricotta: Nothing to disclose.
Posted April 2013

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